<span>I am </span>
<input type="radio" name="agent_type" value="Individual" /><span>An Individual</span><br />
<input type="radio" name="agent_type" value="Agent" /><span>An Agent</span>
<span>I am Offering For</span><br />
<select name="offered"><option value="For Rent">For Rent</option><option value="For Sale">For Sale</option></select>
<br />
<span>Rent</span>
<input type="text" name="rent" />
<select name="period">
	<option value="Day">Day</option>
	<option value="Week">Week</option>
	<option value="Fortnight">Fortnight</option>
	<option value="Month">Month</option>
	<option value="Quarter">Quarter</option>
	<option value="Year">Year</option>
</select>
<br />
<span>Property Type</span>
<select name="property_type">
	<option value="Houses">Houses</option>
	<option value="Flats">Flats</option>
	<option value="Bungalows">Bungalows</option>
	<option value="Parking">Parking</option>
	<option value="Land">Land</option>
</select>
<span>Condition</span>
<select name="condition">
	<option value="Furnished">Furnished</option>
	<option value="Semi-Furnished">Semi-Furnished</option>
	<option value="Un-Furnished">Un-Furnished</option>
</select>
<span>Date Available</span>
<input type="text" name="date_available" />